Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection 25 November 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Bridge Medical Centre on 15 November 2017 as part of our inspection programme.

At this inspection we found:

• Staff treated patients with compassion, kindness, dignity and respect.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Patients told us that they were happy with the care and treatment they received. However there was a mixed response to access to appointments and some patients found it difficult to get an appointment and get through on the telephone.
• The patient participation group was also active. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• The practice did not routinely review the effectiveness and appropriateness of the care it provided.
• Staff were well trained and felt supported by the practice to deliver high standards of care.
• Practice GPs and nurses meet regularly with other clinicians including the fracture liaison nurse and proactive care team to promote continuity of care. Frail and vulnerable patients are seen by GPs and nurses in their own home

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure appropriate steps are taken to mitigate the risk of Legionella.

• Implement a regular programme of quality improvement such as clinical audit to review clinical intervention against national and local guidelines and established best practice.

• Ensure that all recruitment information required by regulation was in place prior to the appointment of staff.

The areas where the provider should make improvements are:

• The provider continues to monitor patient satisfaction levels in relation to patient involvement in decisions and explanation of tests, telephone access and appointment availability to ensure they meet patient needs.
• Review the collation of responses to MHRA alerts to keep a central record that demonstrates actions and outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Bridge Medical Centre on 25 November 2015. Overall the practice is rated as good.

We found that many improvements had been made since our previous inspection of March 2015 when the practice had been rated as inadequate and was placed into Special Measures.

Our key findings across all the areas we inspected were as follows:

• The practice had made significant improvements across all areas of the practice since our last inspection, particularly to address findings in relation to safety and governance within the practice.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. All staff told us that improvements had been made in communication across the practice team since our last inspection.
• The practice proactively sought feedback from staff and patients, which it acted upon.

There were areas of practice where the provider needs to make improvements.

The provider should:

• Implement processes to monitor those children who failed to attend hospital appointments for which they had been referred.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 17 March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the safe management of medicines and cleanliness and infection control.

We undertook this focused inspection on 26 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. A further focused inspection will be undertaken to follow up the remaining breaches of legal requirements. At this stage the overall rating for the practice will remain unchanged. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for on our website at

www.cqc.org.uk

Our key findings across the areas we inspected were as follows:-

• the practice had implemented polices and procedures to ensure the proper and safe management of medicines.

• the practice had arrangements in place to assess the risk of and prevent, detect and control the spread of infections, including those that are health care associated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Medical Centre on 17 March 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and well led services. It was also inadequate for providing services for five of the population groups; older people, people with long term conditions, families, children and young people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was rated good for working age people (including those recently retired and students). Improvements were also required for providing effective and responsive services. It was good for providing caring services.

Our key findings across all the areas we inspected were as follows:

• Systems and processes were not in place to keep patients safe. For example, policies and procedures for ensuring the safe use of medicines were not robust and arrangements for controlling the risk of infection were inadequate
• Not all staff had received the training they required to undertake their roles effectively. For example, the majority of staff had not had training on safeguarding vulnerable adults. Not all clinical staff had been trained or assessed as competent in their roles.
• The practice had not proactively sought feedback from patients during the last year
• The practice had a number of policies and procedures to govern activity but not all of these had been reviewed or were up to date.
• Systems were not in place for identifying capturing and managing issues and risks

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that blank prescription forms are handled in line with current national guidance.
• Ensure that policies and procedures are put in place for ensuring that medicines are kept at the required temperatures, and which describe the action to be taken in the event of a potential failure.
• Ensure that effective procedures are put in place to ensure all medicines are kept within their expiry dates and are suitable for use.
• Ensure that effective procedures are put in place so that equipment used for providing care to patients is regularly checked so that it is safe to use and is used in a safe way.
• Ensure that training is provided to all staff on safeguarding vulnerable adults and that the training is relevant to their role.
• Ensure that action is taken to address identified concerns with infection prevention and control practice.
• Ensure that action is taken to address identified concerns with the training and competencies of phlebotomy staff.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure that feedback is sought and acted upon from patients on an on going basis through patient surveys and regular meetings with the patient participation group (PPG).
• Ensure that systems are put in place to assess, monitor and mitigate risks relating to the health, safety and welfare of patients, staff and visitors to the practice.

Additionally the provider should:-

• Ensure that when a patient’s verbal consent is sought that this is always documented in the electronic patient notes

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six patients over the telephone. We also spoke with two members of the Patient Participation Group (PPG). They spoke positively about the care and treatment they received and described it as, “First class”, “Absolutely brilliant” and “Excellent”. They said that the doctors explained things well and they were able to make informed decisions about their care. They told us that the practice staff were friendly and helpful. Three of the patients we spoke with said they always found it difficult to contact the practice and get an appointment with the doctor when they wanted it.

We spoke with two GPs, the nurse manager, the practice manager, assistant manager and three administrative staff. They all said they felt well supported and had sufficient training to undertake their roles

We found that the practice had policies and procedures in place to safeguard children and vulnerable adults and that staff were aware of their roles and responsibilities in relation to this. This meant that patients who used the service were protected from the risk of abuse.

The practice regularly sought the views of patients through surveys and the PPG. We saw evidence that these were used to improve the service. We also saw that learning from significant events and complaints was identified and that improvements in practice were implemented as a result. This meant the practice had an effective system to monitor the quality of service that patients received.

This practice is rated as Good overall. (Previous rating 25 January 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Bridge Medical Centre on 25 September 2018 as part of our inspection programme. It was also to follow up on breaches of regulations.

At our last inspection on 15 November 2017 we found the provider was in breach of regulations in that:

• The provider had not ensured appropriate steps were taken to mitigate the risk of Legionella.
• The provider did not have a regular programme of quality improvement such as clinical audit to review clinical intervention against national and local guidelines and established best practice.
• Recruitment information required by regulation was not always in place prior to the appointment of staff.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• A programme of quality improvement including clinical audit was established in the practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Not all patients found the appointment system easy to use and reported that there were difficulties in accessing appointments.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• Recruitment practices ensures information required by regulation was in place prior to the appointment of staff.

The areas where the provider should make improvements are:

• Continue to review and improve telephone access and appointment availability and monitor patient satisfaction levels in respect of these areas.

• Review the current level of feedback from the secondary care anti-coagulation service to seek reassurances for practice clinicians as the accountable prescribers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.